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Hendem DU, Oluklu D, Beser DM, Yildirim M, Turgut E, Tanacan A, Sahin D. Evaluation of Fetal Cardiac Functions in Preeclampsia: Does the Severity or Proteinuria Affect Fetal Cardiac Functions? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2415-2424. [PMID: 37310112 DOI: 10.1002/jum.16268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the fetal cardiac functions in preeclampsia and control group, and determine whether the severity or amount of proteinuria affects fetal cardiac functions. METHODS This prospective case-control study involves 48 pregnant women with preeclampsia and 48 healthy women. Pulsed wave Doppler, M-mode, and tissue Doppler imaging were used to measure the cardiac function between the 32 and 34 gestational weeks in each group. All Doppler indices and cardiac function parameters were also compared in subgroups with mild and severe preeclampsia and between subgroups with proteinuria >3 g/24 hours and <3 g/24 hours. RESULTS Decreased diastolic function (decreased E, A, E', and A' values in mitral/tricuspid valves and increased isovolumetric relaxation time) and decreased systolic functions (decreased mitral and tricuspid annular plane systolic excursion and S' value in mitral/tricuspid valves) were detected in the preeclampsia group. Decreased tricuspid E value in severe preeclampsia compared with mild preeclampsia was shown in the present study. CONCLUSION Preeclampsia may cause changes in systolic and diastolic functions in the fetal heart. Subclinical functional changes of these fetuses can be detected earlier and more sensitively with the help of tissue Doppler imaging. Biventricular diastolic functional changes are more prominent in preeclamptic cases with proteinuria >3 g/24 hours.
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Affiliation(s)
- Derya Uyan Hendem
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Oluklu
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Menekse Beser
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Muradiye Yildirim
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Turgut
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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von Dadelszen P, Tohill S, Wade J, Hutcheon JA, Scott J, Green M, Thornton JG, Magee LA. Labor induction information leaflets—Do women receive evidence-based information about the benefits and harms of labor induction? Front Glob Womens Health 2022; 3:936770. [DOI: 10.3389/fgwh.2022.936770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
ObjectivesTo determine the extent to which a sample of NHS labor induction leaflets reflects evidence on labor induction.SettingAudit of labor induction patient information leaflets—local from WILL trial (When to Induce Labor to Limit risk in pregnancy hypertension) internal pilot sites or national-level available online.MethodsDescriptive analysis [n = 21 leaflets, 19 (one shared) in 20 WILL internal pilot sites and 2 NHS online] according to NHS “Protocol on the Production of Patient Information” criteria: general information (including indications), why and how induction is offered (including success and alternatives), and potential benefits and harms.ResultsAll leaflets described an induction indication. Most leaflets (n = 18) mentioned induction location and 16 the potential for delays due to delivery suite workloads and competing clinical priorities. While 19 leaflets discussed membrane sweeping (17 as an induction alternative), only 4 leaflets mentioned balloon catheter as another mechanical method. Induction success (onset of active labor) was presented by a minority of leaflets (n = 7, 33%), as “frequent” or in the “majority”, with “rare” or “occasional” failures. Benefits, harms and outcomes following induction were not compared with expectant care, but rather with spontaneous labor, such as for pain (n = 14, with nine stating more pain with induction). Potential benefits of induction were seldom described [n = 7; including avoiding stillbirth (n = 4)], but deemed to be likely. No leaflet stated vaginal birth was more likely following induction, but most stated Cesarean was not increased (n = 12); one leaflet stated that Cesarean risks were increased following induction. Women's satisfaction was rarely presented (n = 2).ConclusionInformation provided to pregnant women regarding labor induction could be improved to better reflect women's choice between induction and expectant care, and the evidence upon which treatment recommendations are based. A multiple stakeholder-involved and evidence-informed process to update guidance is required.
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Toijonen A, Hinnenberg P, Gissler M, Heinonen S, Macharey G. Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth: a national cohort study. J OBSTET GYNAECOL 2021; 42:49-54. [PMID: 33938353 DOI: 10.1080/01443615.2021.1871888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this retrospective, nationwide Finnish population-based cohort study was to determine whether there is an association between preterm caesarean breech delivery in the first pregnancy and maternal and neonatal morbidity in the subsequent pregnancy and delivery. We identified all singleton preterm breech birth in Finland from 2000 to 2017 (n = 1259) and constructed a data set of the first two deliveries for these women. We compared outcomes of the following pregnancy and delivery among women with a previous preterm caesarean breech section with the outcomes of women with one previous vaginal preterm breech birth. p Value, odds ratio, and adjusted odds ratio were calculated. Neonates of women with a previous caesarean preterm breech delivery had an increased risk for arterial umbilical cord pH below seven (1.2% versus 0%; p value .024) and a higher rate of neonatal intensive care unit admission [22.9% versus 15% adjusted OR 1.57 (1.13-2.18); p value <.001]. The women with a previous caesarean section had a higher rate of uterine rupture (2.3% versus 0%; p value .001). They were also more likely in the subsequent pregnancy to have a planned caesarean section [19.9% versus 4% adjusted OR 8.55 (4.58-15.95), an emergency caesarean section [21.5% versus 9.7% adjusted OR 2.16 (1.28-2.18)], or an instrumental vaginal delivery [9.3% versus 3.8% adjusted OR 2.38 (1.08-5.23)].IMPACT STATEMENTWhat is already known on this subject? Vaginal birth after caesarean section is generally known to be associated with a higher risk of maternal and neonatal morbidity.What do the results of this study add? The following birth after previous caesarean preterm breech section is associated with a higher rate of uterine rupture and with a higher rate neonatal admission to the neonatal intensive care unit and more often an arterial umbilical cord pH below seven regardless of the mode of the following delivery, compared to women with a subsequent delivery after a previous vaginal preterm breech birth.What are the implications of these findings for clinical practice and/or further research? Our results must be considered when counselling patients regarding their first preterm breech delivery, as the selected method of delivery also affects the outcomes of subsequent pregnancies and deliveries.
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Affiliation(s)
- Anna Toijonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Pia Hinnenberg
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Georg Macharey
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Xu X, Wang Y, Xu H, Kang Y, Zhu Q. Association between proteinuria and maternal and neonatal outcomes in pre-eclampsia pregnancy: a retrospective observational study. J Int Med Res 2021; 48:300060520908114. [PMID: 32339047 PMCID: PMC7218474 DOI: 10.1177/0300060520908114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives To evaluate the association between proteinuria and maternal and neonatal outcomes in pregnant women with pre-eclampsia. Methods This retrospective study included patients beyond 20 weeks of gestation diagnosed with pre-eclampsia, who were admitted to Suzhou Municipal Hospital between December 2013 and December 2015. Demographic and clinical data were extracted from clinical records, including age, body mass index, newborn weight and Apgar score. Pre-eclampsia risk factors and perinatal outcomes were analysed. Results A total of 407 patients were enrolled, of whom, 402 with pre-eclampsia were included in the final analyses, divided into two groups: patients with proteinuria (n = 364 [90.55%]) and patients without proteinuria (n = 38 [9.45%]). Newborn 5-min Apgar scores were statistically lower in the proteinuria group versus the group without proteinuria (9.77 versus 9.95). Compared with patients without proteinuria, patients with proteinuria had a significantly higher rate of births before 37 weeks of gestation (50.80% versus 31.60%), but the incidence of preterm membrane rupture was significantly lower (3.8% versus 13.2%). Conclusion Proteinuria may be associated with adverse maternal and neonatal outcomes in cases of pre-eclampsia.
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Affiliation(s)
- Xiangxiang Xu
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Yun Wang
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Hui Xu
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Yan Kang
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
| | - Qin Zhu
- Department of Gynaecology and Obstetrics, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China
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Zhu X, Chen L, Li R. Values of serum sFlt-1, PLGF levels, and sFlt-1/PLGF ratio in diagnosis and prognosis evaluation of preeclamptic patients. Clin Exp Hypertens 2020; 42:601-607. [PMID: 32338084 DOI: 10.1080/10641963.2020.1756313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To explore the values of serum sFlt-1, PLGF levels and sFlt-1/PLGF ratio in the diagnosis and prognosis evaluation of preeclamptic patients. METHODS From March 2017 to October 2018, 60 cases of early onset preeclampsia (E-PE), 116 cases of late onset preeclampsia (L-PE) and 50 cases of gestational hypertension (GH) were selected. Fifty women who had vaginal bleeding or abdominal distention before 34 gestational weeks were selected as an early control group, and 50 pregnant women awaiting delivery were selected as a late control group. Serum sFlt-1 and PLGF levels were measured, and changes of sFlt-1/PLGF ratio were analyzed. Their correlations with neonatal birth weight were analyzed, and ROC curves were plotted for E-PE diagnosis. RESULTS The sFlt-1/PLGF ratio of patients with E-PE was significantly higher than those of other groups, and negatively correlated with neonatal birth weight. When the ratio was used as a diagnostic index, AUC was 0.975. The ratio of patients with severe L-PE exceeded that of cases with mild L-PE. In all preeclamptic patients, the ratio was elevated with increasing maternal and neonatal complications. CONCLUSION sFlt-1/PLGF ratio is valuable for assessing the severity of preeclampsia and diagnosing E-PE, and can be used to predict neonatal birth weight.
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Affiliation(s)
- Xiaohe Zhu
- Second Department of Obstetrics, Shandong Weifang People's Hospital , Weifang, P. R. China
| | - Limin Chen
- Habitual Abortion Clinic, Shandong Weifang People's Hospital , Weifang, P. R. China
| | - Ran Li
- Habitual Abortion Clinic, Shandong Weifang People's Hospital , Weifang, P. R. China
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Yılmaz Baran Ş, Alemdaroğlu S, Durdağ GD, Yetkinel S, Yüksel Şimşek S, Kalaycı H, Şimşek E. Reappraisal of the relationship between 24-hour proteinuria and preeclampsia in terms of the maternal and perinatal outcomes. Hypertens Pregnancy 2020; 39:82-88. [PMID: 32037908 DOI: 10.1080/10641955.2020.1725038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: This study evaluated the association between proteinuria levels and maternal, and perinatal outcomes of preeclampsia patients and determined the cutoff values for predicting severe complications.Methods: We retrospectively evaluated the records of 412 patients with proteinuric preeclampsia.Results: Median proteinuria levels were significantly higher in patients with severe maternal and adverse perinatal outcomes than in those without such outcomes, except in cases of placental abruption and late preterm delivery.Conclusion: Proteinuria levels may aid in diagnosing preeclampsia and indicating early intervention. The revised guidelines do not suggest that proteinuria encountered during pregnancy is clinically insignificant.
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Affiliation(s)
- Şafak Yılmaz Baran
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Songül Alemdaroğlu
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Gülşen Doğan Durdağ
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Selçuk Yetkinel
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Hakan Kalaycı
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Erhan Şimşek
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Adana, Turkey
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Tanacan A, Fadiloglu E, Beksac MS. The importance of proteinuria in preeclampsia and its predictive role in maternal and neonatal outcomes. Hypertens Pregnancy 2019; 38:111-118. [PMID: 30939965 DOI: 10.1080/10641955.2019.1590718] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate impact of 24-h proteinuria level in preeclampsia on maternal/perinatal outcomes. METHODS Singleton pregnancies with preeclampsia delivered after 24 weeks of gestation were included. Patients were divided into mild (0.3 to <2 g) (n=72), severe (2 to <5 g) (n=30), and massive (≥5 g) (n=24) proteinuria groups, and cut-off values of 24-h proteinuria for composite adverse maternal and neonatal outcomes were calculated. RESULTS Twenty-four hour proteinuria level cut-offs for composite adverse outcomes were 3275 mg (72.2% sensitivity, 85.6% specificity) and 2395 mg (72.7% sensitivity, 78% specificity) respectively. CONCLUSION Severe and massive proteinuria were related to poor maternal, perinatal, and neonatal outcomes.
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Affiliation(s)
- Atakan Tanacan
- a Division of Perinatology, Department of Obstetrics and Gynecology , Hacettepe University , Ankara , Turkey
| | - Erdem Fadiloglu
- a Division of Perinatology, Department of Obstetrics and Gynecology , Hacettepe University , Ankara , Turkey
| | - Mehmet Sinan Beksac
- a Division of Perinatology, Department of Obstetrics and Gynecology , Hacettepe University , Ankara , Turkey
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Sachan R, Patel ML, Sachan P, Shyam R, Verma P, Dheeman S. Diagnostic accuracy of spot albumin creatinine ratio and its association with fetomaternal outcome in preeclampsia and eclampsia. Niger Med J 2017; 58:58-62. [PMID: 29269982 PMCID: PMC5726174 DOI: 10.4103/0300-1652.219345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Hypertensive disorders in pregnancy are one of the leading causes of maternal and perinatal mortality. Proteinuria is one of the common and important features of preeclampsia. To evaluate the diagnostic accuracy of albumin-creatinine ratio (ACR) in woman with preeclampsia and eclampsia and examine the association between ACR and fetomaternal outcome. Materials and Methods: Prospective study carried out over a period of 1 year in the Department of Obstetrics and Gynaecology, after informed consent and ethical clearance total ninety pregnant women from gestational age 20 to 40 weeks were enrolled, including, thirty preeclampsia, thirty antepartum eclampsia, considered as cases and thirty normotensive pregnant women as controls. Preeclampsia was defined as per National High Blood Pressure Education Program 2000 working group. All patients were asked for a spot midstream urine sample, followed by 24 h urine collection. Urinary protein was estimated by the sulfosalicylic acid method and creatinine by the Jaffe's method. The urinary ACR was determined by automated analyzer. Results: Mean value of urinary ACR of controls was significantly lower (0.103 ± 0.037) as compared to both groups. On comparing between groups the difference was significant (<0.001), a strong correlation between urinary ACR levels and 24 h urinary proteins was observed. Conclusion: In our study, an association of raised ACR values with severity of disease as well as with adverse fetomaternal outcome was observed.
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Affiliation(s)
- Rekha Sachan
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Munna Lal Patel
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pushpalata Sachan
- Department of Physiology, Career Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Radhey Shyam
- Department of Geriatric and Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pratima Verma
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Soniya Dheeman
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
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